Most aches and pains that present to an osteopath are musculoskeletal and can be treated safely with conservative care. However, part of an osteopath’s role is recognising when symptoms don’t fit the usual pattern and further medical investigation is needed. Some serious conditions can initially look very similar to an ordinary muscle or joint problem.
Osteopathic training takes 4 years full time, and to remain registered, an osteopath must complete 30 hours of study every year. So you’re in good hands when we’re your first port of call.
When Calf Pain Isn’t a Calf Injury
A deep vein thrombosis (DVT) can sometimes look like a pulled calf muscle. Pain, swelling, warmth, and tenderness in one leg can all occur with a DVT, but these symptoms can also follow a sporting injury.
There may be particular risk factors, including recent surgery, prolonged immobility, pregnancy, or taking certain medications. A suspected DVT needs urgent medical assessment because a clot can travel to the lungs and cause a pulmonary embolism.
For this reason, we would not massage or manipulate a calf if there were concerns about a DVT. Instead, we would refer you for appropriate medical assessment.
Compartment Syndrome
Acute compartment syndrome is another emergency that can initially present as severe limb pain. It is usually associated with trauma, such as a fracture or crush injury, and occurs when pressure builds up inside one of the muscular compartments of the limb.
Pain that seems excessive, particularly alongside numbness, weakness, swelling, or changes in skin colour, warrants immediate assessment. Outcomes vary dramatically if surgical treatment is provided within the first 12h or not.
Acute compartment syndrome can cause permanent damage to muscles and nerves if treatment is delayed. This is very different from chronic exertional compartment syndrome, which develops gradually with exercise and may be suitable for conservative management.
Chest Pain
Chest pain is another example where we would be particularly careful about diagnosis. Problems involving the ribs, spine, or surrounding muscles can cause chest pain. Conditions such as costochondritis can be particularly convincing because the pain may be reproduced by movement or pressure.
However, pain from the heart or lungs can sometimes present in ways that are less obvious. Chest pain associated with breathlessness, sweating, nausea, dizziness, or pain spreading to the arm, jaw, back, or neck requires urgent medical assessment.
When in doubt, it is safer to investigate first.
Headaches and Neurological Symptoms
Most headaches are not caused by something dangerous. A sudden, severe headache, particularly one that reaches maximum intensity very quickly, needs urgent assessment. New neurological symptoms such as weakness, facial drooping, difficulty speaking, loss of vision, confusion, or significant changes in sensation should also be investigated. A stroke can sometimes be confused with Bell’s palsy, particularly when facial weakness is the main symptom.
Other red flags include a new headache after significant trauma, a headache with fever and neck stiffness, or a substantial change in a long-standing headache pattern.
Cauda Equina Syndrome
Even though we cover this in more detail in our post on lower back pain and red flags, it is important enough to repeat.
Cauda equina syndrome occurs when the nerves at the bottom of the spinal cord become compressed. It can cause severe lower back pain and leg symptoms, but the particularly important warning signs are:
- new difficulty passing urine or loss of bladder control
- loss of bowel control
- numbness around the genitals, anus, or inner thighs
- significant or progressive weakness in the legs
These symptoms require immediate emergency assessment. Similar to compartment syndrome, hours make a difference.
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